Healthcare Provider Details

I. General information

NPI: 1629544846
Provider Name (Legal Business Name): MORGAN ASHLEY MARTINEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 ATLANTIC AVE STE 210
LONG BEACH CA
90807-4569
US

IV. Provider business mailing address

971 S IDAHO ST UNIT 18
LA HABRA CA
90631-6639
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-1886
  • Fax:
Mailing address:
  • Phone: 323-747-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108300
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number130273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: